Devices and methods for left atrial appendage closure

Abstract

Tissue stabilizing devices and methods for stabilizing, and optionally closing, a target tissue, such as the left atrial appendage, generally include an elongate body with a first lumen and a second lumen, a suction tip coupled to the elongate body, and an injection tip coupled to the elongate body proximal of the suction tip. The suction tip may define a suction aperture and the suction aperture may be in fluid communication with the first lumen to apply suction to the target tissue. The injection tip may be in fluid communication with the second lumen to dispense a contrast fluid.

We claim: 
     
       1. A method of closing a target tissue, comprising:
 advancing a tissue stabilizing device towards the target tissue, wherein the tissue stabilizing device comprises an elongate body comprising a first lumen and a second lumen, the first lumen being concentrically-disposed within the second lumen, wherein a suction tip is fluidly coupled to the first lumen, an injection tip comprising radial apertures is fluidly coupled to the second lumen, the radial apertures being circumferentially disposed in a sidewall of the injection tip, wherein the injection tip is fixed relative to the suction tip, wherein the injection tip comprises an annular aperture at a distal end of the injection tip, wherein the annular aperture extends up to a distal end of the suction tip, wherein the annular aperture comprises a diameter larger than a diameter of the second lumen; 
 applying vacuum to the target tissue through the first lumen; 
 injecting, through the second lumen and around the suction tip via the radial apertures, a fluid toward the target tissue; 
 visualizing the target tissue using the injected fluid; 
 advancing a closure device along the tissue stabilizing device toward the target tissue; and 
 closing the target tissue with the closure device. 
 
     
     
       2. The method of  claim 1 , wherein the closure device comprises an elongate body comprising a lumen therethrough, a snare loop, and a suture loop releasably coupled to the snare loop. 
     
     
       3. The method of  claim 2 , wherein closing the target tissue comprises advancing the snare loop and the suture loop around the target tissue and tightening the suture loop around the target tissue. 
     
     
       4. The method of  claim 2 , wherein the tissue stabilizing device is positioned within the lumen of the elongate body of the closure device during advancement of the closure device toward the target tissue. 
     
     
       5. The method of  claim 1 , wherein the fluid is injected prior to applying vacuum and the method further comprises identifying the target tissue using the injected fluid prior to applying the vacuum thereto. 
     
     
       6. The method of  claim 1 , wherein the fluid is injected after applying the vacuum and the method further comprises confirming application of the vacuum to the target tissue using the injected fluid. 
     
     
       7. The method of  claim 1 , wherein the fluid is injected toward the target tissue prior to applying the vacuum. 
     
     
       8. The method of  claim 7 , further comprising identifying the target tissue using the injected fluid prior to applying the vacuum thereto. 
     
     
       9. The method of  claim 1 , wherein the fluid is injected toward the target tissue after advancing the closure device toward the target tissue. 
     
     
       10. The method of  claim 1 , wherein the target tissue is a left atrial appendage. 
     
     
       11. The method of  claim 10 , further comprising rinsing a pericardial space with saline. 
     
     
       12. The method of  claim 11 , further comprising placing a pericardial drain, wherein the saline in the pericardial space is evacuated using the pericardial drain. 
     
     
       13. The method of  claim 1 , wherein the first lumen and the second lumen of the elongate body of the tissue stabilizing device are tubular. 
     
     
       14. The method of  claim 1 , wherein the suction tip and the injection tip are integrally formed. 
     
     
       15. A method of closing a target tissue, comprising:
 advancing a tissue stabilizing device towards the target tissue, wherein the tissue stabilizing device comprises an elongate body comprising a first lumen and a second lumen, the first lumen being concentrically-disposed within the second lumen, wherein a suction tip is fluidly coupled to the first lumen of the elongate body, wherein the suction tip comprises a diameter larger than a diameter of the elongate body, an injection tip comprising radial apertures fluidly coupled to the second lumen of the elongate body, the radial apertures being circumferentially disposed in a sidewall of the injection tip, and wherein the suction tip is fixed relative to the injection tip, wherein the injection tip comprises an annular aperture at a distal end of the injection tip, wherein the annular aperture extends up to a distal end of the suction tip, wherein the annular aperture comprises a diameter larger than a diameter of the second lumen; 
 injecting, through the second lumen of the elongate body and around the suction tip via the radial apertures, a first injection of contrast fluid toward the target tissue through the injection tip; 
 applying vacuum to the target tissue through the suction tip; 
 injecting, through the second lumen of the elongate body and around the suction tip via the radial apertures, a second injection of contrast fluid toward the target tissue through the injection tip; 
 advancing a closure device along the tissue stabilizing device toward the target tissue, 
 wherein the closure device comprises an elongate body comprising a lumen therethrough, a snare loop, and a suture loop releasably coupled to the snare loop; 
 advancing the snare loop and the suture loop around the target tissue; and 
 tightening the suture loop around the target tissue. 
 
     
     
       16. The method of  claim 15 , further comprising identifying the target tissue with the contrast fluid from the first injection and confirming application of vacuum to the target tissue with the contrast fluid from the second injection. 
     
     
       17. The method of  claim 15 , further comprising injecting a third injection of contrast fluid toward the target tissue through the injection tip, wherein the third injection occurs after advancing the snare loop and the suture loop around the target tissue. 
     
     
       18. The method of  claim 17 , further comprising confirming the snare loop has captured the target tissue with the contrast fluid from the third injection. 
     
     
       19. The method of  claim 18 , further comprising injecting a fourth injection of contrast fluid toward the target tissue through the injection tip, wherein the fourth injection occurs after tightening the suture loop around the target tissue. 
     
     
       20. The method of  claim 19 , further comprising confirming the target tissue is closed with the contrast fluid from the fourth injection. 
     
     
       21. The method of  claim 15 , further comprising releasing the vacuum from the target tissue prior to tightening the suture loop. 
     
     
       22. The method of  claim 15 , wherein the target tissue is a left atrial appendage. 
     
     
       23. The method of  claim 22 , further comprising rinsing a pericardial space with saline. 
     
     
       24. The method of  claim 23 , further comprising placing a pericardial drain, wherein the saline in the pericardial space is evacuated using the pericardial drain. 
     
     
       25. The method of  claim 15 , wherein the first lumen and the second lumen of the elongate body of the tissue stabilizing device are tubular. 
     
     
       26. The method of  claim 15 , wherein the suction tip and the injection tip are integrally formed.